It brings saddened tears to my eyes when I hear beautiful empowering birth stories, that end with women still considering the option of caesarean section for their next birth, due to bad perineal (skin between vagina and anus) tearing. Why is perineal trauma sometimes the finale of what can be one of the most amazing experiences of a woman’s life? It just doesn’t seem fair.
My friend Kim, blogs about her life as a missionary in Johannesburg. Recently, on “kimlovesjozi“, she discussed her hopes and fears, in the lead up to her second birth. She outlined her thoughts about her birth choices, formulated somewhat by the perineal trauma she sustained from her first birth. I too, can empathise.
After my first birth I was left with quite a bad 2nd degree tear (1st degree involves tears only skin deep, 2nd is skin and muscle layers, 3rd is skin, muscle and anal sphincter and let’s not talk about 4th degree). I was bruised black and blue and couldn’t sit down properly for weeks. I did muse about whether a caesarean would be easier, but vaginal birth still came up trumps in my mind. I would prefer a few weeks of discomfort “down below” to having anaesthetic, having a major operation and a much bigger cut in my stomach, not to mention the weeks of recovery not being able to pick up my baby, cough or laugh, without pain. That’s just my opinion.
Don’t hear me say all caesareans are bad. Some people absolutely need them. I just believe there has to be a really good reason to risk all the associated morbidities.
I wasn’t scared about tearing (though I thought it was probably inevitable) in my second birth because I knew what to expect. I think people worry about feeling the tear when it happens. For the majority of people who tear, the sensation you feel is relief not extra pain. This is because the moment you tear is usually when you are the most stretched, so tearing releases the stretching feeling and then a millisecond later your baby is born and you’re consumed with feelings for your beautiful bundle. People also worry a lot about the actual stitching, but for me the bad thing about stitching was the local anaesthetic and even that only felt like a little bee sting. Nothing compared to the birth I’d just endured. I could only feel the actual stitching as a touch sensation, like if you pinch the skin on the back of your elbow.
Some women sustain very severe perineal tears and subsequent complications, such as incontinence or dyspariunia (pain on intercourse). I can understand why these women choose to have elective caesareans. However, if you sustain a bad tear but heal well and have no associated complications, there is hope for future births. I have personally known quite a few cases where women have even had 3rd degree tears in their first birth and then gone on to have intact perineums, or only very minor tears, with following births.
Fear associated with perineal trauma can grossly inhibit the progress of labour, particularly during second stage (beginning with full dilatation, ending with birth of baby). I was a bit nervous about tearing during my first birth, but I tried to maintain the mindset of “if it happens, it happens and I’ll deal with it then”. Fear of birth can also increase a woman’s experience of pain. I can testify to this; I coped with the pain of Levi’s birth until I stopped progressing, at which point I became fearful of the outcome of my planned home birth. From that point onwards my pain got exponentially worse. With Arlo’s birth, I had done a lot of work (seeing a psychologist and reading and practicing strategies from the “calmbirth” course notes) to prepare my mind for the possibility of feeling that extent of pain again. I’m not lying when I say that his birth truly did not hurt as much. The pain was bearable as I was working with it, not against it. I even enjoyed labour, strange as that may sound.
“Calmbirth” also talks about acknowledging that your body knows how to birth your baby the perfect way for you both. If you try and breathe through the contractions (also called waves or surges) instead of holding your breath and pushing, then your perineum will not be tense, will be allowed to stretch as it should and will be less likely to tear. Again this was true for me. Second time around I tried hard to breathe instead of holding my breath and pushing until I turned blue like my first birth. The pushing feeling is really intense so the only way I managed not to push was by blowing raspberries against the wall of the pool. The result was that I only got a very minor tear (where I had non-stretchy scar tissue) that only required 2 stitches.
My encouragement to all pregnant women aiming for a natural vaginal birth, whether you’ve had babies or not, with or without perineal trauma, is – preparation is the key. Prepare your body and mind with exercise, reading natural birth books and going to a childbirth course (like Calmbirth). Hopefully then you will learn about positioning, breathing techniques and pain management strategies to facilitate you to have a good and satisfying birth experience (with hopefully no perineal trauma!).